Zdunek Kinga, Schröder-Bäck Peter, Alexander Denise, Rigby Michael, Blair Mitch
Public Health Department, Medical University of Lublin, Lublin, Poland.
Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Child Care Health Dev. 2019 May;45(3):364-370. doi: 10.1111/cch.12657.
In the European context the awareness of societal responsibility for children's health has increased with greater attention to children's rights and child empowerment processes. Child health issues are considered particularly sensitive; thus, they often provoke strong societal reactions, which, as a consequence, influence national health policies across Europe. Effectiveness of societal influences increases with the involvement of various actors in the context.
A qualitative approach was used to identify the level of societal involvement in health decision-making. A questionnaire was sent to the Country Agents (CAs) of the Models of Child Health Appraised (MOCHA) project. CAs are contact points in each of the 30 participating in the project countries and were asked to identify strong public and professional discussions related to child health services in their countries. Data collection was undertaken between July and December 2016.
Based on 71 case studies, we identified eight thematic patterns, which characterize societal reactions to the currently worrisome child health issues across Europe. We devoted our attention to the three most controversial: child vaccination, child poverty and child abuse. The cases described by the CAs show the broad perspective in the perception of child health problems. Child health issues involve the public and raise nationwide debates. Public concerns were directly or indirectly related to child health and depicted the national overtone.
Concerns in Europe about child health care are twofold: they are devoted to systemic issues (indirect patient orientation) and to child health and well-being (direct patient orientation). The phenomenon of societal responsibility for children's health is important for the support of public acceptance of child health policy.
在欧洲范围内，随着对儿童权利和儿童赋权进程的更多关注，社会对儿童健康责任的认识有所提高。儿童健康问题被认为特别敏感；因此，它们常常引发强烈的社会反应，进而影响整个欧洲的国家卫生政策。随着各种行为体的参与，社会影响的有效性会增加。
采用定性方法来确定社会在卫生决策中的参与程度。向儿童健康评估模型（MOCHA）项目的国家代理人（CAs）发送了一份调查问卷。CAs是参与该项目的30个国家中每个国家的联络点，被要求确定其所在国家与儿童健康服务相关的强烈的公众和专业讨论。数据收集于2016年7月至12月进行。
基于71个案例研究，我们确定了八个主题模式，这些模式表征了欧洲社会对当前令人担忧的儿童健康问题的反应。我们将注意力集中在三个最具争议性的问题上：儿童疫苗接种、儿童贫困和虐待儿童。CAs描述的案例展示了对儿童健康问题认知的广泛视角。儿童健康问题涉及公众并引发全国性辩论。公众关注直接或间接地与儿童健康相关，并呈现出国家特色。
欧洲对儿童医疗保健的关注有两个方面：它们致力于系统性问题（间接以患者为导向）和儿童健康与福祉（直接以患者为导向）。儿童健康的社会责任现象对于支持公众接受儿童健康政策很重要。
